Lumbar Spine, Exercise and Conflicts

Discussions relating to Lower Back Pain.

Lumbar Spine, Exercise and Conflicts

Postby cathy » Wed Jun 20, 2007 2:09 am


i just recently found this site, so even though I have been reading quite a bit, forgive me, if I am repeating questions already answered.

Its obvious you're a strong advocate of exercise for back pain. A little of my personal history. I have alot of OA, that much, was early onset in my 30s. I have had one knee replacement and getting ready for another. I am not overweight and right now weigh 133 pounds. My mother also had early onset OA.

I also have arthritis in my cerebral and lumbar spine. most bothersome is the lower back... I had an MRI about a year ago, that showed disc-degradation at L-5/S1 with discogentic endplate changes, diminished disc signal, broad-based disc buldge and osteophyosis and bilateral foraminal stenosis worsened by facet arthropathy. Moderate disc degradation at L4-5, L3,4 L2-3. Facet arthropathy bilaterally at L4-5. Periarticular inflammation of the left facet joint at L4-5 level and bone marrow signal alteration compatible with stress reaction.

there is also facet joint inflammation on the left at the L3-4 level.

First of all, I dont even know for sure what this says except i have arthritis. My OS who is not a spine specialist but rather a knee and hip doc. has ordered aggresive PT for my lower back. Now, when I went for PT, the therapist informed me that it would only make it worse. Well, I dont want worse, I want better, so I cancelled my pt. I have previsouly had epidurals in my lower spine with very little, if any relief. my pain radiates down the outside of my left leg all the way to about 2 inches about my ankle. it is like a burning fire with numbness. I am trying to get ready for the TKR and would really like to get the back pain under control.

Also I can take no aspirins or NSAID, COX-2 or any other arthritis meds because of recurrent ulcers. So is exercise the answer or not? Being given conflicting advise is making me crazy.

i would think if we could get the inflammation under control that would be a plus, but without any arthritis meds I dont know how to accomplish that.

Thank you for any advise. I promise subsequent postings will not be this long...

I am 55 and retired but I worked for 30 years on my feet, lifting, bending, walking all day, everyday. I only stopped working when it was no longer possible to do my job. :(

Postby cygnet » Wed Jun 20, 2007 9:13 am

Hi Cathy,

Your post is interesting to me because I too have arthritis. I'm in my thirties, and it runs in my family - early onset.

They say that exercise and stretching are very very important for managing the symptoms of arthritis, so I would think that Dean's exercises would be beneficial to you. Let's see what Dean has to say about it.

We have to keep in mind that almost everyone gets arthritic changes in their spine eventually...but not everyone has pain from it.

I believe exercise, stretching and a healthy diet with lots of fresh fruits and vegetables rich in antioxidants can help reduce inflammation from arthritis, and make it less painful. Being at a healthy weight helps take stress off the joints too.

I've seen how debilitating arthritis can be. My mother is in her early 60s, and has had two total knee replacements, two hip replacements, an ankle fusion, and is now considering lumbar fusion. She has very limited mobility. She has been overweight and sedentary for many years, which hasn't helped.
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Postby Dean » Wed Jun 20, 2007 1:46 pm

Hi Cathy,

The way I see it, there are two schools of thought on PT:

1) Aggressive PT, and
2) Low impact, gentle PT where you slowly and progressively increase the intensity.

Aggressive PT is great for getting professional athletes back on the field and employees back to work in the shortest possible time. I don't know for certain, but I suppose that most insurance companies only want to pay for a certain number of sessions and so the therapist has to try and get as much done within that time frame. (Entirely conjecture on my part... that may have nothing to do with it.)

I prefer the second option because it has less of a chance to make things worse. In my back pain book for example, I like to have people spend a full month just on a few basic exercises. After that I have them slowly start to add in what I call "advanced exercises" over the next several months. (Most of the advanced exercises are still pretty low impact.)

It's a slower process, but you're in total control and can modify it to suit your needs. For example, if one exercise does cause you problems, you can drop it and just do the others.

I believe the slow progressive approach is better because it gives your body time to adapt and adjust to the increasing stress.

Aggressive PT works... and sometimes works better than my way. On the other hand, I hear from a lot of people who say they tried PT with no luck and yet they have great results with my program. Both approaches are technically just physical therapy.

Hope that answers your questions,
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Postby Guest » Wed Jun 20, 2007 9:26 pm

cynget, thank you for your response....Like you I also thought exercise would help. goodness, I have been to some of these back pain forums where MRIs didn't read near as significant as mine and many of those folks are on Narcotic drips and morphine patches. Say what? Thats not for me. Years ago when I could take nsaids and later the Cox-2 I had alot more mobility than I do now and alot less pain. but they are not an option so I have to deal with that.

I was thrown a loop when the PT later told me that what my OS had ordered would only make things worse. The truth is, it is going to get worse anyway. I already know that. It is progressive so worse is going to happen but I want to be able to deal with it better than I am now. My biggest fear is being in a wheelchair.

im sorry your mother has to go through all this. Best of luck to you and her.

Dean, i think your advise sounds right on. im going to soon order your book and give this low impact expercise program a shot and see what happens.Also, what do you think about aquatic PT? I know following my TKR, once I had healed enough at 6 weeks post op to be in water, the pool made a big difference with pain control and doing the exercises. I just have not tried it for my back. Thank you for all your advise.. I'll be back and try to also pick up more knowledge from everyone who posts here. ... :)

Postby Dean » Wed Jun 20, 2007 11:52 pm

I've never done aquatic PT myself, but I've heard good things about it. I suppose I should look into it some day and learn more about it. It sounds like a very good idea.
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